Pre- and postoperative risk factors for hospital complications upon atypically localized left atrial myxomas

Introduction: Cardiac myxoma is the most common of the benign heart tumor. In the left atrium, it is typically located in the interatrial septum in the area of the fossa ovale; any other its localization is considered atypical. The consequences of surgical treatment of typical myxomas have been sufficiently examined; however, there are no data on treatment of atypically localized left atrium myxomas. Objective: The study is aimed to analyzing the results of surgical intervention upon atypically localized left atrium myxomas and assessing of pre- and postoperative risk factors for adverse hospital events as well as embolic complications. Methods: A retrospective review of the results upon surgical treatment of atypically localized left atrial myxomas (n = 52) through the period from 2008 to 2022 was performed. Results: Non-lethal in-hospital complications are revealed in 15 patients (29%). In-hospital mortality is 6% (n = 3). A comparative analysis of transthoracic echocardiography data, collected before surgical intervention and at the time of hospital discharge, demonstrated a decrease in the left ventricular end diastolic volume and in the left atrial dimensions (P < 0.001). Risk factors for non-lethal in-hospital complications are related to the chronic heart failure NYHA 3 (P < 0.01) and EuroSCORE II (P = 0.03). Risk factors for hospital mortality are associated with advanced age (P = 0.03) and EuroSCORE II (P = 0.03). Preoperative embolic complications are attributed to localization of myxoma on the posterior wall of the left atrium (P = 0.02), villous myxoma (P < 0.001), myxoma prolapse into the left ventricle cavity (P = 0.05). Conclusion: The presented results of surgical treatment of atypically localized left atrium myxomas are comparable to the data of the world literature, including hospital mortality rates (6%). Preoperative risk factors for non-lethal complications are related to chronic heart failure NYHA 3 and EuroSCORE II; for lethal complications they are associated with the age of patients over 65 years and EuroSCORE II. No significant effect of postoperative risk factors on lethal and non-lethal hospital complications was revealed.